Table 2.

Differences in Rural and Urban Home Health Care Agency Quality Metrics

Patient-Level Quality Metrics
Study	Home Health Care Utilization	Emergency Room Visits	Hospitalizations	Other Care Process	Quality of Patient Care Experience
Chen 2016			Urban heart failure patients were more likely to have 30-day preventable hospitalizations.		Rural agencies had lower patient-experience ratings, lower harm prevention scores and lower improvement in activities of daily living.
Cotton 2017				Mixed results: Rural patients more likely to receive controlled medications. No differences for benzodiazepine and hypnotics.
Falvey 2018	Rural patients had lower physical therapy utilization after total knee arthroplasty.
Falvey 2020	Rural patients had fewer rehabilitation visits after a stay in an intensive care unit.
Iyer 2016	Mixed results: Rural patients received fewer rehabilitation specialists visits. Rural patients received fewer physical therapy visits. No difference in the number of visits after stroke.
Koru 2018		Rural patients had more ER visits.	Rural patients had more hospitalizations.
Rahman 2020	Rural patients with Alzheimer Disease and Related Dementia had fewer home health care days.
Agency-Level Quality Metrics
Study	Home Health Care Utilization	Emergency Room Visits	Hospitalizations	Other Care Process	Quality of Patient Care Experience
Chen 2020		Rural agency patients had more ER visits.			Rural agencies had lower patient-experience ratings, lower harm prevention scores and lower improvement in activities of daily living.
Mroz 2018			Rural agencies more likely to have patients admitted to hospitals.
Mroz 2020	Rural agencies had smaller percentages of patients utilize home health care services.
Shang 2021				Mixed results: Urban agencies less likely to provide staff vaccinations on-site or for free and more likely to use cultures to determine infections. Rural agencies more likely to have infection prevention and control policies for patients with central lines.
Smith 2017					Urban agencies less likely to be top performers.

Note: Bold indicates worse access, processes or outcomes. Italics indicates better access, processes or outcomes. Underlined indicates mixed results.